JAC-Antimicrobial Resistance最新文献

Background: There are concerns with the availability of substandard antibiotics across Africa, including Ethiopia, exacerbating high levels of antimicrobial resistance (AMR). There are ongoing initiatives across Africa to reduce their availability to reduce AMR, including Pan-African registration, coordination with Interpol, and increasing surveillance. Consequently, the objective of the study was to evaluate the quality of different brands of clarithromycin tablets currently marketed in Ethiopia as a key antibiotic.

Methods: A total of 120 tablets of 12 different brands of clarithromycin 500 mg tablets were purchased from 12 different community pharmacies. Quality control tests, including visual inspection, thickness, diameter, hardness, friability, weight variation, disintegration, dissolution, and assays, were conducted at the Ethiopian Pharmaceutical Company's drug quality control laboratory on the sourced tablets. Tests were performed in accordance with the United States Pharmacopoeia (USP) and the World Health Organization's procedures.

Results: The identification test results confirmed the presence of the active pharmaceutical ingredients. The weight variation tests showed compliance with the USP limits. All clarithromycin brands and tablets met the USP requirements for hardness and disintegration times. The percentage content of all brands and tablets ranged from 95.14% to 100.44%, meeting the USP specifications. The dissolution tests also met required USP limits alongside factor (f1) factor (f2) values, which were within acceptable ranges.

Conclusion: As a result, all tested clarithromycin brands conformed with the required quality standards and were of acceptable quality. Consequently, these different brands of clarithromycin can be used to effectively treat patients and support ongoing national efforts to ensure antibiotic quality and strengthen AMR containment strategies.

Background: Antimicrobial resistance (AMR) poses a significant public health threat. Individuals in contact with the criminal justice system, including individuals in custody, prisons, jails or youth offending institutions, may be particularly vulnerable due to living conditions, behaviours and pre-existing health issues. This review assesses bacterial AMR and antibiotic use in this population.

Methods: A rapid systematic scoping review was conducted (OSF: https://doi.org/10.17605/OSF.IO/XHCFJ). Embase, Medline and Scopus were searched for studies published between 1 January 2010 and 28 September 2023. One author screened all records, with 10% dual screened. Included studies examined AMR bacteria or antibiotic use among people in contact with the criminal justice system (including people in custody, prisons, jails or youth offending institutes). Study quality was assessed using the Newcastle-Ottawa Scale and STROBE AMS checklist. Findings were synthesized narratively as evidence was limited and heterogeneous, which prohibited planned meta-analyses.

Results: Sixteen papers met inclusion criteria; eight were at lower risk of bias. Three studies examined antibiotic use, reporting common inappropriate prescribing (n = 1) and associations between recent antibiotic use and resistant infections (n = 2). Fourteen papers reported AMR findings, most with a focus on Mycobacterium tuberculosis and Staphylococcus aureus. Drug-resistant TB prevalence in prison populations ranged from 5.2% to 37% (n = 4). Methicillin resistant Staphylococcus aureus colonization ranged from 8.1% to 8.8% (n = 4). Other bacteria examined included Salmonella spp., Acinetobacter spp., Group A Streptococcus, and Mycoplasma genitalium.

Conclusions: People in contact with the criminal justice system face heightened risks of resistant bacterial infections. However, with only three studies addressing antibiotic use, evidence is limited. Addressing AMR in this group requires collaborative and targeted public health interventions.

[This corrects the article DOI: 10.1093/jacamr/dlaf211.].

Background: Antimicrobial stewardship programs (ASPs) are essential to improve antibiotic prescribing. This study evaluated the impact of a post-prescription audit and feedback intervention on carbapenem prescribing appropriateness in a large university hospital.

Methods: This retrospective observational study utilized interrupted time series (ITS) analysis, employing an Autoregressive Integrated Moving Average (ARIMA) model, to assess carbapenem prescribing across three consecutive phases: a 12-month pre-intervention, a 6-month intervention, and a 6-month post-intervention follow-up. Carbapenem prescribing appropriateness was retrospectively evaluated using an in-house developed algorithm, based on international and national guidelines and institutional protocols. The intervention involved bedside consultations by infectious diseases specialists employing a post-prescription audit with face-to-face feedback.

Results: We evaluated 1825 carbapenem therapies, primarily prescribed for suspected/confirmed bloodstream infections (46%, 843/1825). Among these, 458 (25%) were deemed inappropriate, mainly due to unnecessarily broad-spectrum use (72%, 331/458). The ITS-ARIMA model showed an immediate 11% reduction in the rate of inappropriate prescriptions during the first month of intervention phase (P = 0.001), followed by a non-significant downward trend during the remaining intervention period. However, an immediate 14.9% increase in inappropriate prescriptions was observed at the onset of the post-intervention phase (P = 0.001), indicating a rebound effect after the withdrawal of the active stewardship intervention.

Conclusions: Implementing a post-prescription audit and face-to-face feedback intervention was associated with a short-term improvement in carbapenem prescribing appropriateness. We observed a reduction in the trend of inappropriateness, although this change was not statistically significant. Future studies should investigate strategies for implementing sustainable ASPs optimizing human resources and time investment.

Background: Pathogens causing neonatal sepsis have developed resistance to antimicrobial treatment, resulting in the convergence of two public health issues; neonatal mortality and antimicrobial resistance. There are a few published studies presenting data from South Africa regarding neonatal sepsis pathogen and resistance profiles.

Methods: We conducted a systematic review of bacterial and fungal neonatal sepsis pathogens and antimicrobial resistance profiles from 2005 to 2022.

Results: Nine studies were included from 1235 screened. Most studies were from two provinces in South Africa and were conducted at academic hospitals. A single study included data collected nationally. Significant heterogeneity was noted, precluding the value of conducting a formal meta-analysis. There was significant variability in prevalence of pathogens, dependent on whether studies included coagulase negative Staphylococci (CoNS) or not. Studies that included CoNs reported higher prevalence for Gram-positive organisms compared with Gram-negative organisms versus studies that did not include CoNS. A higher proportion of Gram negatives compared with Gram positives and fungi was noted. Consistently low susceptibility to WHO first line empiric therapy was reported in most studies and low susceptibility to second line therapy reported in some studies. Seven studies reported mortality, which ranged from 15.6% to 46.3%.

Conclusion: The prevalence of pathogens causing neonatal sepsis in South Africa are consistent with those on the WHO list of priority bacterial and fungal pathogens. A high percentage resistance to WHO first and second line treatment is noted and emphasizes the importance of country specific surveillance for neonatal sepsis.

Objectives: To evaluate the synergistic activity of ampicillin/sulbactam plus ceftazidime/avibactam in a collection of carbapenem-resistant Acinetobacter baumannii (CR-Ab) from different regions in Peru.

Materials and methods: One hundred and eighty-four CR-Ab isolates were included in this study. They were identified by amplification of bla _OXA-51 and confirmed by MALDI-TOF (matrix-assisted laser desorption ionization time of flight) mass spectrometry and 16S rRNA sequencing. Susceptibility to ampicillin/sulbactam and carbapenems was determined by the disc diffusion method. Synergy was assessed using discs containing ampicillin/sulbactam and ceftazidime/avibactam. The EDTA-disc synergy test was used to screen metallo-β-lactamase-producing isolates, and in isolates showing synergy, the presence of bla _NDM was confirmed by PCR. Statistical analysis was performed using Fisher's exact test.

Results: High levels of resistance to ampicillin/sulbactam were found in the study. Thus, 1.1% (2/184), 11.4% (21/184) and 87.5% (161/184) of isolates were classified as susceptible, intermediate and resistant to ampicillin/sulbactam, respectively. Synergistic activity was observed in 97.2% of the non-susceptible CR-Ab isolates. The presence of metallo-β-lactamase producers (all bla _NDM) was observed in three isolates (1.6%).

Conclusions: These findings demonstrate high levels of synergistic activity between ampicillin/sulbactam and ceftazidime/avibactam and their potential use as a treatment for CR-Ab.

We describe here how we guide and work with over 100 secondary- and tertiary-care hospitals in Thailand to support the effective use of their antimicrobial resistance (AMR) surveillance data for local actions, and with policy makers for national actions. At the facility level, the guidance includes: (i) validating data, (ii) comparing data with previous reports, (iii) comparing data with other hospitals with similar levels of care and bed count, (iv) comparing cluster signals with infection prevention control records, and (v) identifying wards with hyperendemic hospital-origin AMR infections. At the national level, the guidance includes monitoring national estimates, systematically benchmarking hospital-level estimates, and developing national guidelines for empirical antimicrobial therapy. We encourage hospitals and policy makers in other low- and middle-income countries to explore, adopt and adapt this guidance, ensuring their AMR surveillance data are effectively used for their local and national actions based on their context and constraints.

Background: Rapid and accurate antimicrobial susceptibility testing (AST) is essential for managing Gram-negative bacteraemia. However, a major limitation of conventional phenotypic AST is its slow turnaround time, delaying targeted therapy.

Objectives: To evaluate the performance and turnaround time of direct-from-blood culture AST using an automated phenotypic system in paediatric patients with Gram-negative rod bacteraemia.

Methods: We retrospectively reviewed 135 positive blood cultures with Gram-negative rods from a tertiary paediatric hospital between January 2021 and December 2023. Blood cultures that yielded polymicrobial organisms were excluded from the study. Direct AST was performed by preparing bacterial suspensions directly from positive blood culture broth and analyzed using an automated phenotypic AST system (BD Phoenix^™ M50). Conventional AST from isolated colonies served as the reference. Essential agreement (EA), categorical agreement (CA), and error rates [very major error (VME), major error (ME), minor error (mE)] were assessed. Time to AST result was compared between methods.

Results: The direct AST method reduced the median turnaround time by 24.0 h compared with conventional AST (P < 0.0001). Overall EA and CA were 99.5% and 99.6%, respectively. No VMEs were observed. ME and mE rates were low at 0.25% and 0.25%, respectively, with discrepancies tending to indicate greater resistance by direct AST.

Conclusions: Direct-from-blood culture AST using an automated phenotypic system provides rapid, accurate susceptibility results in paediatric Gram-negative bacteraemia. This approach enables earlier reporting and may improve clinical outcomes and antimicrobial stewardship without additional resource burden.

Antimicrobial resistance (AMR) is a global health challenge that disproportionately affects countries and regions with limited resources. Current efforts to address AMR largely emphasize antimicrobial stewardship (AMS), community engagement and scientific research, while often overlooking systemic factors such as corruption, poverty and inflation, which significantly influence the capacity of individuals and communities to respond effectively. In this article, we suggest that AMR responses must extend beyond traditional AMS and community engagement to adopt a genuinely people-centred approach-one that empowers individuals not only to achieve optimal health but also to navigate broader social and economic constraints. To our knowledge, this is the first report to critically examine the combined impact of corruption, poverty and inflation on AMR.